Downloadable PDF - APA Division 42 Psychologists in Independent

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Independent Practitioner
Winter 2016 • Volume 36 Number 1
division42.org
What Division 42 Means to Me
42 reflects the status of
psychology within APA, the
private practitioner
Tony Puente
Transformative
Alan Entin
I typically do not speak or write on the
list serve. I do however read it. Or most
of it.
I think Div 42 in this manner. Informative, discussion, knowledge, and connection, with help that is there if i have a
question.
Karen Spoor, Ph.D.
Division 42 meant support, collegiality, and guidance as I entered the world of private practice
almost five years ago. I continue to learn from
Division 42 members through their conferences
and listserv, and I cannot say enough about the
member’s vast knowledge and experience and
their willingness to guide, mentor, and share their
experiences with others in the field. I am forever
grateful.
Jennifer Imig Huffman, Ph.D.
Division 42 means to me:
community
colleague support
great referral network
Nancy McGarrah, Ph.D.
Independent
Practitioner
Editor: Stephanie T. Mihalas, PhD, NCSP
www.division42.org
About the Independent Practitioner
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Submission deadlines: February 10 for Spring issue
May 10 for Summer issue
Associate Editor: Andrea Kozak MIller, PhD
July 20 for Fall issue
November 15 for Winter issue
Dean of Psychology
Capella University
225 South 6th Street, 9th Floor
Minneapolis, MN 55402
(612) 372-8294
[email protected] or [email protected]
Submissions:
Bulletin Staff
Patrick DeLeon, PhD, JD, Opinions and Policy Contributing Editor
Daniel Goldman, PhD, S/ECP Contributing Editor
Ryan Witherspoon, MA, Multicultural and Diversity Contributing
Editor
Maria Papachrysanthou Hanzlik, PsyD: Focus on Clinical Practice
Contributing Editor
Kimberly L. Smith, PsyD, Liability, Malpractice, and Risk Management Contributor
Dave Shapiro, PhD, Forensic Co-Contributing Editor
Nicole Davis, PsyD, JD, Forensic Co-Contributing Editor
Rick Weiss, Layout Design Editor
Division 42 Central Office
Advertisements are accepted at the Editors’ discretion and should not
be construed as endorsements.
Copyright:
Except for announcements and event schedules, material in the Independent
Practitioner is copyrighted and can only be reprinted with the permission
of the Editor.
Board of Directors
Executive Committee
Lori Thomas, JD, PhD, President
Norman Abeles, PhD, President-Elect
June WJ Ching, PhD, Past-President
Michael Schwartz, PsyD, Secretary
Gerald Koocher, PhD, Treasurer
Members-At-Large
Lindsey Buckman, PsyD
Judith Patterson, PhD
Elaine Ducharme, PhD David Shapiro, PhD
Keeley Kolmes, PsyD
Rachel Smook, PsyD
Representatives to APA Council
Armand Cerbone, PhD
Lenore Walker, EdD
Nancy Molitor, PhD
Robert Woody, PhD
Robert Resnick, PhD
Jeffrey Younggren, PhD
Stephanie Mihalas, PhD
Student Representative
Sam Marzouk, MA
2
All materials are subject to editing at the discretion of the Editors. Unless
otherwise stated, the views expressed by authors are theirs and do not
necessarily reflect official policy of Psychologists in Independent Practice,
APA, or the Editors. Publication priority is given to articles that are original
and have not been submitted for publication elsewhere.
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Governance and Standing Committee Chairs
APA Governance Issues: Norman Abeles, PhD
Awards: June WJ Ching, PhD
Fellows: Elaine Ducharme, PhD
Finance: Gerald Koocher, PhD
Membership: Judith Patterson, PhD
Nominations and Elections: June WJ Ching, PhD
Program: Lauren Berman, PhD
Publications and Communications: Terrence Koller, PhD
Continuing Committees
Advertising: TBD
Advocacy: Peter Oppenheimer, PhD
Diversity: Lindsey Buckman, PsyD and Armand Cerbone, PhD
Forensic Section: I. Bruce Frumkin, PhD
Marketing and Public Education: Pauline Wallin, PhD
Mentorshoppe: Lisa Grossman & Michael Schwartz
Appointments
Bulletin Editor: Stephanie Mihalas, PhD
Bulletin Associate Editor: Andrea Kozak MIller, PhD
Continuing Education: Robin McCleod
Federal Advocacy Coordinator: Peter Oppenheimer, PhD
Forensic/Assessment Conference: I Bruce Frumkin, PhD
Fast Forward Conference: Nancy Molitor, PhD
Winter 2016
Table of Contents
President’s Column:
Sustainability, Leadership Development, Innovation, and Diversity — Lori Thomas 4
Opinions and Policy:
Innovative Training Opportunities – For Those with Vision — Pat DeLeon
8
Liability, Malpractice, and Risk Management:
Intersecting Identities and Patient Feedback: Considerations for Ethical Practice —
Kimberly L. Smith
10
Focus on Clinical Practice:
The Power of Possessions in the Family Inheritance Drama — Steven Hendlin
14
From Research to Practice — Sara J. Giachino and Andrea Kozak Miller
17
Friends with Benefits — Dana Charatan
20
Focus on Business of Practice:
Growing a Group Practice in the Face of Healthcare Reform — Samantha Slaughter 25
Early Career Psychologists:
Self-Care Considerations for Early Career Psychologists — Karin Lawson
27
Multicultural and Diversity:
Building Self-awareness and Enhancing Multicultural Competencies in Practice — Aaron A.
Gubi, Joel O. Bocanegra and Adrienne Garro
31
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Winter 2016
3
PRESIDENT’S COLUMN
Sustainability, Leadership Development,
Innovation, and Diversity
Lori Thomas
I
am simultaneously humbled by the awesome responsibility of being chosen to serve
as your 2016 President and excited to follow
in June Ching’s footsteps. You have heard it
said that “it takes a village. . .” Likewise, I think
that a leader’s success is due, in large part, to
the many contributions and support provided
by the persons who are a part of her community. In this community of practitioners, there
are so many whose mentorship, kind words,
or urging, have inspired me and contributed
to both my personal and professional development. As someone for whom spirituality is a
grounding element, I truly feel
blessed to have
found a “home” in
this Division and
call a number of
my learned colleagues, friends.
Thus, it is with
this spirit that I
look expectantly
toward my Presidential year.
Over the past
year, I have had
the opportunity
to work closely with June, and have admired
how her collaborative style of leadership and
her deliberate infusion of culture, strengthened the sense of community within the Board.
Moreover, my work with June and my colleagues on the Board has given me the opportunity to consider the needs of our Division and I
am poised to continue much of the important
work begun by my predecessors.
4
The latter part of 2015 was challenging for us
as a profession, an organization, and as a Division. Spurred by the release of the Hoffman
Report and the diversity of perspectives that
followed, you as members asked us, your leaders, to re-evaluate the concepts of transparency
and communication within the Division, and
we did. June, with the support of the Board
responded to member concerns by increasing
access to information on Board activities on
behalf of the Division. Moreover, June pulled
together an action committee led by Gordon
Herz to brainstorm about more efficient methods of communication between members and
the Board. Further, Lenore Walker, on behalf
of your council reps, has been posting regular
informational updates on the Listserv. In this
next year, I look forward to hearing more from
members about how we can maintain the open
flow of communication between our Board and
our members.
_________
My focus in 2016 will be on the broad themes
of sustainability, leadership, innovation, and
Winter 2016
diversity. These four themes have also served
as a backdrop for the Division’s 2016 programming at Convention in Denver, which is being
spearheaded by Program Chair, Lauren Behrman, who has been a frequent presenter at Fast
Forward as well as Division programs at Convention. I hope to see many of you in Denver!
Sustainability and Innovation: I was introduced
to Division 42 approximately 6 years ago and
was immediately drawn to 42’s sense of community, which for me, was due in large part, to
the open exchange of knowledge and the generosity with which members gave of their time.
Six years, and a number of volunteer roles later,
that sense of community within the Division
is still evident. As in any community, at times
there are vigorous debates and lively conversations, which in the end, tend to highlight
areas of needed change. Six years ago, I was also
drawn to the Division’s spirit of innovation.
This innovation is evident not only in Listserv
posts but also through the presentations provided at Convention programming and at our
Forensic and Fast Forward Conferences. The
Forensic and Fast Conferences, launched almost
four years ago, and chaired by Bruce Frumkin
and Nancy Molitor, respectively, have gifted
this Division with comprehensive and cutting
edge programming; a space for members to
learn about new practice areas; the opportunity to develop and maintain competencies in
practice; and plenty of opportunities to meet
with colleagues for scholarly discourse and of
course, just plain fun.
One charge that we have as a Division, is to
ensure that 42 continues to both serve as a
resource for, and further the interests of, practitioners. Sustainability, governed in large part
by the ability to create new ideas that meet the
needs of a changing landscape, is an important component, not only in our businesses,
but in this Division. Declining membership
and a reduction in dues paying members is
an ongoing challenge for our Division. The 42
Board has been, and in 2016, will continue to
identify both cost-saving and income-producing measures for the Division. You may have
already noted that in 2015, after many years of
forgoing increases in member dues, the Board
voted during Convention, to increase our membership dues, effective for 2016. Having been
a member of the Board for much of my time in
this Division, I can affirm that decisions regarding the sustainability of our Division, are the result of careful and painstaking discussion; and,
often an idea may take the dedication of many,
and successive years, to come to fruition.
Thus, in 2016, I will have not only the honor
and privilege of celebrating the fruit of ideas
that had their genesis in the work of past Presidents, including Lisa Grossman, Nancy Molitor,
Jeff Younggren, Steve Walfish, Gordon Herz,
and June Ching, but also the responsibility of
ushering forward ideas that are still in their
infancy.
Here are few highlights of ideas that were
planted in previous years and will bear fruit in
2016. These are projects that will have some
short and long-term impacts on sustainability:
In an effort to manage Division costs, the Board
voted to have the IP go digital. This issue is
our premiere digital IP issue! Editor, Stephanie
Mihalas, has developed a comprehensive plan to
keep the IP on the cutting edge. Associate Editor
Andrea Kozak Miller and contributing editors,
Nicole Davis, Pat DeLeon, Daniel Goldman, Maria
Hanzlik, David Shapiro, Kimberly Smith, and
Ryan Witherspoon. Thanks also to Rick Weiss
for creative layout design.
The Membership Committee under the direction of Judith Patterson will begin an appeal
asking lifetime members to support our Division with a financial gift.
The Division 42 APF Fund (The Next Generation Fund), which achieved its fundraising goal
in 2015 will, under the direction of Laura Barbanel and Lisa Grossman, finalize guidelines for
the disbursement of funds to eligible psychology students and early career psychologists.
The Advocacy Committee, now under the direction of Peter Oppenheimer, will continue its
efforts to address issues that have an impact on
professional practice.
Winter 2016
5
This year, Nancy Molitor and Bruce Frumkin
will guide the Board in evaluating the pros and
cons of having one annual conference versus
two annual conferences.
The Continuing Education Committee Chair,
Robin McCleod, new to Division 42 leadership,
will lead the charge in investigate the feasibility
of additional CE offerings for the Division.
The Division’s new Journal Practice Innovations,
under the direction Dr. Steve Walfish, Editor,
will publish its inaugural issue in March 2016.
Our Student and ECP members issued a call
for more learning opportunities and in 2016,
the Student and Early Career Psychologist will
respond by offering 7 Virtual Learning hours
specifically geared to our S/ECP members.
Leadership Development and Diversity: As an
African-American woman who is intimately
connected to her Caribbean heritage, the importance of celebrating culture and one’s differences is particularly salient. Moreover, it is
poignant, that I have the distinct pleasure of
assuming the reins for leading this Division on
the heels of another woman of color.
Division 42 has historically made strides to
address diversity. Some of these initiatives
have included creating a multicultural tool kit,
instituting a Diversity Committee and a Diversity Task Force, and providing support for the
Multicultural Summit that meets every two
years. Moreover, our Forensic Conference has
offered specific programming on the impact of
cross-cultural considerations in forensic assessment, the IP has regularly featured articles
that highlight important aspects of diversity,
and the Student/ECP Committee has, over the
past year, had scholarship opportunities for our
S/ECP members, particularly those of color, as
one of its focal points. However, in the words of
the “The Golden Boy” Oscar De la Hoya “there is
always space for improvement, no matter how
long you’ve been in the business.”
Sustaining a thriving community such as ours
requires the availability of enthusiastic, creative, and hardworking individuals who are
willing to answer the call of leadership. More6
over, fostering a community, rich in people
resources, requires individuals diverse not only
in their backgrounds and places of origin, but
those diverse in their perspectives, experiences,
and ideology.
In 2016, the following projects will have short
and long-term impacts on diversity and leadership development.
Implementing June’s initiative of including a
diversity component to the Division’s popular
Mentorshoppe program – chairs, Lisa Grossman
and Michael Schwartz.
Creating a formal leadership pipeline for participation in Division governance – chair, Lisa
Grossman.
A research to practice collaboration between
Division 42 and Division 35.
_________
In 2016, I look forward to working with you,
the 42 community, on issues relevant to the
practice community. Moreover, I am thrilled to
have the collective and extensive knowledge
provided by our Board of Directors.
Parenthetically, you will note that many of your
elected leaders are serving multiple roles in this
Division. There is much work to be done and I
encourage interested members to seek opportunities to become a part of this committed team
of volunteers.
Your 2016 Board Executive Committee will
comprise of June Ching (Immediate Past President); Noman Abeles (President-Elect); Michael Schwartz (Secretary), and Gerald Koocher
(Treasurer). Additionally, there are 14 other
volunteers who comprise the Board of Directors. These individuals include the Division’s
six council of representatives Armand Cerbone, Nancy Molitor, Robert Resnick, Lenore
Walker, Robert Woody, and Jeff Younggren; six
members-at-large including Lindsey Buckman,
Elaine Ducharme (also serving as this year’s
Fellows Chair), Keely Kolmes, Judith Patterson, David Shapiro, and Rachel Smook; and the
Student and ECP Representatives, Sam Marzouk
and Stephanie Mihalas, respectively.
Winter 2016
Please join me in welcoming Norman Abeles,
Armand Cerbone, Lindsey Buckman, and Sam
Marzouk to our Board. I look forward to working collaboratively with Norman Abeles over
the next year as he prepares to lead our Division
in 2017.
meeting in New Orleans at the end of January
2016. Look forward to receiving minutes and
updates about the meeting.
In closing, please join me in expressing gratitude to the following individuals who have
either completed their terms of service on the
Board or are transitioning from their committee leadership position. Many thanks to:
Armand Cerbone is returning to the 42 Board in
a new role as Diversity Council Rep and will also
be co-leading our Diversity Committee. In 2015,
Larry Riso, whose leadership of the IP, yielded stelLindsey Buckman served as our Social Media
lar articles of interest to our practice community.
Work Group co-chair and in 2016, she will be
serve on the Board in her elected role as the DiDouglas Haldeman who completed his term as
versity Member-at-Large. She will also continue
Diversity Council of Representatives.
to serve as the Social Media-Co- Chair and CoChair of the Diversity
Committee.
“In order to carry a positive action, we must develop here a
Along with the Board positive vision.”
of Directors many of
your colleagues have
agreed to continue
on in their leadership roles in Division committees. In addition to the individuals mentioned earlier in this column, in 2016, Terrence
Kohler will continue in his role as Publication
and Communications Chair (P&C) and provide
oversight for many of Division activities that
members find beneficial, including the Listserv
workgroup, which will welcome new co-chairs
Shannon Nicoloff and Derek Phillips (also the
Social Media Work Group co-chair). Moreover,
Pauline Wallin, will continue in her role as
Chair of the Marketing and Publication Committee.
The Board will be having its Winter Board
— Dalai Lama
Michi Fu who completed her term as Diversity
Member-at-Large.
Sallie Hildebrant, who has led the advocacy
charge for this Division for many years and will
continue to contribute her energy and experience to the committee in 2016.
Edward Zuckerman who has chaired the Divisions CE committee will be remaining as a
committee member.
Keely Kolmes who is stepping down from her
role as chair of the Listserv workgroup. Keely
Kolmes will continue in her elected role as
Member-at-Large.
4th Annual Division 42
Forensic Psychology Conference:
Psychological Assessment, Ethics and Expert Testimony
April 29-May 1, 2016
Hilton Pasadena - Pasadena, CA
This symposium brings together the leading national experts in the field to focus on:
• New developments and practice standards in forensic assessment and testing
• Cross-Cultural applications in forensic assessment
• Specialty areas in forensic practice
• Expert testimony
Registration information will be available on the Division 42 website at www.division42.org
Winter 2016
7
Opinions and Policy:
Innovative Training Opportunities —
For Those with Vision
Pat DeLeon
C
hanging Times: Over a decade ago, in
2003, the Institute of Medicine (IOM)
issued its report Informing the Future: Critical
Issues in Health. Most noteworthy: “A person’s
behavior and social circumstances have a
remarkably strong effect on his or her health.
Taken together, behavioral patterns and social
circumstances are estimated to account for
more than half of the premature deaths in the
United States each year. Yet medical schools
often do not cover these topics, or do so only
superficially. IOM is conducting a study to
identify ways to make the behavioral and social
sciences an integral part of medical education.”
Several of psychology’s visionary educators
are exposing their students to the medical and
interprofessional aspects of health care by developing innovative and accredited training experiences, thereby preparing the next generation
of practitioners for the unprecedented challenges and opportunities of the coming century. Gil Newman and Bob McGrath, for example,
are placing students within local Federally
Qualified Community Health Centers (FQHCs),
where they work within primary care, rather
than in more traditional co-located specialty
mental health services.
The federal health center initiative was created during the Great Society Era of President
Lyndon Johnson. They are located primarily
in medically underserved areas and are a core
component of the health care delivery system
for low-income and minority populations.
In 2012, 21 million patients, the majority of
whom were either uninsured (36%) or publicly
insured (49%), made 85.6 million visits to the
nation’s nearly 1,200 FQHCs operating in 8,500
sites. The Commonwealth Fund reports that
8
the percentage of FQHCs exhibiting medium
or high levels of medical home capacity almost
doubled between 2009 and 2013, from 32%
to 62%. Patient-centered Medical Homes and
Accountable Care Organizations are a critical
component of the Obama Administration’s
vision of developing systems of integrated and
interprofessional team-based comprehensive
care with an emphasis upon prevention.
A Personal
Perspective: At the
Uniformed
Services
University of
the Health
Sciences
(USUHS),
Neil Grunberg (along
with his
medical
school colleagues Eric
Shoomaker
and John
McManigle)
has effectively integrated leadership skills into the annual Operation Bushmaster training program.
“Every year in October, students from USUHS
Schools of Medicine (including the Department
of Medical and Clinical Psychology) and Nursing participate in a four-week training exercise
known as ‘Operation Bushmaster.’ The first
two-weeks of didactic training provide the
groundwork for unit cohesion, with a follow-on
week of independent study incorporated for
mastery of many of the concepts. During the final week, students ‘deploy’ to a training facility
to conduct simulated medical missions and are
exposed to many of the same stressors experienced during combat deployments (i.e., lack of
Winter 2016
sleep, high operational tempo, fatigue, and austere living conditions). Additionally, Operation
Bushmaster provides an atmosphere where
inter-professional collaboration transpires and
learning the unique perspectives of each discipline is highly encouraged.
“During this field exercise, Psychiatric Mental
Health Nurse Practitioner (PMHNP) students and
Clinical Psychology students played the roles of
patients with mental health illnesses such as psychosis, mania, depression, anxiety, and substance
use disorders. While simulating roles of Battalion Surgeon (senior medical officer) and Combat
Stress Control, the graduating medical students
and Family Nurse Practitioners (FNP) students
assessed and treated mental health ‘patients’ presenting with acute and chronic symptoms.
“This year, PMHNP students joined with Clinical Psychology students to form the Brigade
Combat Stress Control (CSC) team. In this
shared role, students evaluated the behavioral
health needs of the medical platoons participating in Operation Bushmaster. The Unit
Behavioral Health Needs Assessment Survey
(UBHNAS) is a comprehensive survey developed
to assess the overall behavioral health status
and needs of a military unit. However, those
of us in mental health developed a shortened
version of this tool for use during the training
exercise. Our modified UBHNAS assessed the
status of each platoon in five critical domains:
leadership, leadership cohesion, morale, communication, and training. Following the assessment students provided direct feedback to
the Platoon Leader on methods for improvement and in areas for sustainment within each
team. Additionally, the Brigade Combat Stress
Control team offered brief psychological interventions (such as humor, relaxation exercises
(i.e., deep breathing), and discussions of resiliency) to platoon members. On returning from
the field, a presentation to Command Leadership was given by the CSC team, where we received feedback on our performance by faculty
members [Marlene Arias-Reynoso, Patricia
Smith, and Lutisha Jackson, PMHNP students].”
View https://www.youtube.com/watch?v=IWNJ6kdQpqY if interested.
Developments in Illinois: On June 25, 2014, Illinois joined Guam, New Mexico, and Louisiana
in enacting comprehensive prescriptive authority (RxP) legislation. The Illinois Psychological
Association took the innovative approach of
opening the Master’s level training in Clinical
Psychopharmacology to those who are still at
the pre-doctoral level, a far-reaching educational policy position long proposed by former APA
President Bob Resnick, Bob Ax, and Gene Shapiro. Furthermore, because the law requires seven undergraduate science courses, Illinois now
has undergraduate psychology students enrolling in “pre-prescribing” specialty curricula.
Beth Rom-Rymer’s report: “It’s been 17 months
since the Illinois State Legislature passed our
prescriptive authority legislation by overwhelming margins and 16 months since former Governor Pat Quinn signed SB 2187 into
law. We Illinois psychologists have not let any
grass grow under our feet. The process for the
approval of our law’s Rules and Regulations is
almost complete. We expect that the effective
date for our law will be March 1, 2016.
“Two of the largest state Universities in Illinois
– the University of Illinois, Champaign-Urbana
and Southern Illinois University, with 33,000
and 13,000 undergraduates, respectively, now
have the undergraduate concentration for the
‘pre-prescribing psychologist.’ Some of our Universities are planning a 4+1 academic program
that will combine the B.S. in Psychology with
the M.S. in Clinical Psychopharmacology. Those
students who earn the combined degrees will
then have a very competitive opportunity when
they apply for their doctoral programs in psychology. Several Universities and Professional
Schools are working on developing the M.S.
curriculum in Clinical Psychopharmacology for
their current graduate students as well as for
practicing psychologists around the country.
“More than 20 Illinois hospitals and medical
centers are creating rotation opportunities
for the prescribing psychology trainees. The
number of participating hospitals and medical
centers continues to grow and includes Illinois’
most renowned teaching hospitals. The legal
mandate that we must participate in a series of
nine medical rotations (e.g., internal medicine,
pediatrics, and family medicine) affords pre-
Winter 2016
9
scribing psychology trainees yet another opportunity to form collaborative alliances with
physicians by observing first-hand their treatment procedures while functioning as independent members of multidisciplinary treatment
teams. Even our Illinois psychiatrists are more
than willing to partner with us to meet the
needs of our patients who are desperate for
good, accessible mental health care. Over 90 Illinois practicing psychologists are currently in
training, ranging in age from 23-83. Our oldest
trainee, an addictionologist, asserts that her
patients will be better served with her being
trained as a prescribing psychologist. We have
established strong collaborative relationships
with NAMI and various governmental and law
enforcement agencies in the state. In a remarkable development, county mental health boards
are raising funds to pay for the training of
prescribing psychologists in their jurisdictions.
There is a growing, widespread recognition
that prescribing psychologists can transform a
broken mental health system.” Aloha,
Pat DeLeon, former APA President – Division 42 –
November, 2015
Liability, Malpractice, and Risk Management
Intersecting Identities and Patient Feedback:
Considerations for Ethical Practice
Kimberly L. Smith
I
ntersectionality starts from the premise that
people live multiple, layered identities derived from social relations, history and the operation of structures of power. Initially used as
a descriptive term to address how race and gender might intersect as forms of oppression, intersectionality is now used broadly and widely
to include other social factors such as disability,
sexual orientation, religion, economic status
and class, and many others. Intersectionality is
rooted in Black feminist thinking, and coined
by Black legal scholar Kimberlé Crenshaw, who
uses the following analogy to concretize the
concept:
“Consider an analogy to traffic in an intersection, coming and going in all four directions. Discrimination, like traffic through an
intersection, may flow in one direction, and
it may flow in another. If an accident happens in an intersection, it can be caused by
cars traveling from any number of directions
and, sometimes, from all of them. Similarly,
if a Black woman is harmed because she is in
an intersection, her injury could result from
sex discrimination or race discrimination. .
10
. . But it is not always easy to reconstruct an
accident: Sometimes the skid marks and the
injuries simply indicate that they occurred
simultaneously, frustrating efforts to determine which driver caused the harm.” (Crenshaw, 1989. p. 149)
The overarching concept is based on the premise that people are members of more than one
community at the same time, and can simultaneously experience oppression and privilege
(Ontario Human Rights Commission, 2001).
The
focus
of this
article is
to utilize
intersectionality
as a tool
for analysis and
advocacy
in feedback sessions with patients, in the context of
assessment or psychotherapy. The article further intends to help clinicians address multiple
discriminations and conceptualize how different sets of identities impact access to rights
Winter 2016
and opportunities. I invite you as you read this
through the article to consider your intersecting identities and the impact it has on multiple
levels in the therapeutic setting.
What does this all mean? Intersectionality
shifts the focus from one aspect of a person’s
identity to the multiple ways that shape consciousness, experience behavior (AWID, 2004).
Integrating intersectionality into the conceptualization of the individual reframes how psychologists view the whole person in the context
of their condition and life circumstances, and
vice versa. It further shapes framing of the
feedback from not only helpful to meaningful.
Asking questions related to discrimination and
oppression is difficult and may be uncomfortable. However, regardless of the setting, whether in assessment or psychotherapy, our ethical
obligation to patients remain the same: to
provide meaningful information and care that
is relevant and takes into account historical,
social, and political contexts of patients being
served. Examples of intersecting identities
include:
•
“I am White. I am female. I belong to the
lower working class. I am straight. I am
disabled. I am a total of all of these separate
parts.”
•
I am a man, father, brother, cancer survivor,
high school dropout, college graduate. I am
relatively well off, married with children. I
am Jewish and I’m HIV positive.”
•
I’m a biracial, bicultural, body builder. I am
affluent. I am an ally. I live with an intellectual disability. I am well educated. I am an
alcoholic. I am a Christian.”
•
“Black, queer, and genderqueer educator,
activist, writer and musician.”
Feedback and its Unique Position in the
Hierarchy of Assessment
Feedback is an interactive, dynamic process
that is integral to communicating therapeutic
information in the context of the whole person (Gorske & Smith, 2009). Many psychologists are not formally taught to give feedback,
and on-the-job training models vary (Postal &
Armstrong, 2013). Whether learning to provide
clinically relevant and ethical training during
practicum, internship, postdoctoral studies—
or all three, it most likely did not include integrating intersectionality into the feedback
session. As patients are a collaborative and
active participant in the therapeutic and feedback process, it is safe to assume that feedback
at the initial encounter. Providing feedback in a
stratified society that is ethical and consistent
with good clinical practice requires psychologic
to utilize their psychotherapy training skills,
as the session itself can be therapeutic in many
ways (Gorske & Smith, 2009). Patients may
experience a wide-range of emotional reactions
when learning about certain results or hearing
certain information related to their treatment
ranging from anxiety, fear and sadness to
happiness, peace, and a sense of relief. Processing this information within the domain of the
feedback session is not only clinically relevant,
but kind, compassionate and ethical (Postal
& Armstrong, 2013). Given this information,
once can certainly consider feedback a primary
element of the therapeutic process.
Consider These Questions to Broadly Shape
the Feedback Encounter When Integrating
Intersectionality
•
What forms of identity are critical organizing principles for the community/region
(beyond gender, consider race, ethnicity,
religion, citizenship, age, caste, ability) in
which you work?
•
Who are the most marginalized women,
men, and youth in the community and why?
•
What social and economic programs are available to different groups in the community?
•
Who does and does not have access or control over productive resources and why?
•
Which groups have the lowest and the highest levels of public representation and why?
•
What laws, policies, and organizational
practices limit opportunities of different
groups?
Winter 2016
11
•
What opportunities facilitate the advancement of different groups?
•
What initiates would address the needs of
the most marginalized or discriminated
group in society?
Strategies for providing meaningful feedback and recommendations for individuals
with intersecting identities.
Think differently about identity, equality, and
power. Acknowledge that these parts impact the
total sum of the person. There is little compartmentalization that occurs naturally between
identity, equality, and power, as each of these
have the ability to impact patients on multiple
levels. Candidly discussing feedback and how
to implement recommendations is not only
validating, but empowers patients to develop
self-efficacy surrounding their mental health.
To illustrate, a psychologist providing feedback
to a patient who feels disempowered because of
external systemic oppression may empower the
patient by incorporating them into the decision
making process. One way to address this is as
follows: “This evaluation is one aspect of your
overall functioning. It is not perfect. That is why
it’s important for me to spend time getting to
know you. I remember in the clinical interview
you mentioned feeling as if you did not have a
say in your life. You also mentioned difficulty
with adhering to recommendations if you are
not included in, and understand the process. I
am going to give you the tools to better understand what is going on and we will discuss and
decide on the next steps together.” It would not
be consistent with intersectionality to say, “This
evaluation is one aspect of your overall functioning. It is not perfect. The feedback and recommendations I’m giving you today are in your
best interest and I hope you follow them.” This is
not exemplary of intersectionality as it does not
directly address the inequality that the patient
voiced experiencing, and does not demonstrate
an understanding of how a patient’s experience
might impact behavior.
Take into consideration how different sets of
identities impact a patient’s rights and opportunities. This is a basic tenet, but one that is
easily forgotten. Go beyond access to services
12
and consider power differentials, interpersonal
factors, socioeconomic status, patient preferences, and other factors as necessary when providing recommendations and referrals for further
treatment. A patient from a low socioeconomic
background and reduced quality of education
voices that they prefer to have family members
accompany them to the feedback session. They
clearly are concerned about their family member
and, as they are not accustomed to the mental
health system, they may have many questions.
The therapist might begin the feedback session
by saying, “I am glad you and your family are
here to participate in your recovery and overall
care. It truly takes a village. I’ll you update you
all to give you some background on what’s going
on. Before I start, I want you to know that I love
questions. The more questions the better. It is
my job to help each of you string her to understand what the information I provide means for
John and his overall quality of life. You are key
to his recovery. I will go over the information
today and also give to you in writing. Our communication doesn’t have to stop when you leave.
I am here to answer any questions you have
about the meaning of the results, treatment, and
anything else that comes up related to this. This
is consistent with intersectionality as it takes
into consider power relationships and allows the
patient and their family to control the process. It
would not be consistent with intersectionality
to say, “I’d prefer if your family waited for you
outside in the waiting area. We can bring them
in at a later date once they have reviewed the
information. If they have any further questions,
I am happy to talk to the then.” This communication sends the explicit message that the therapist holds the power and the relationship is not
based on equality, which the patient may experience in society.
Use a “bottom-up” approach. A “bottom-up”
approach starts with an understanding of how
patients actually live their lives then, provides
specific feedback and recommendations “upwards,” accounting for multiple influence that
shop who they are. Essentially, instead of providing recommendations first and augmenting
them to fit patient needs, start with the patient
and their particular life story and provide
recommendations that fit within the parame-
Winter 2016
ters of their life. An example includes working
with an elderly gentleman who recently moved
to the U.S. You understand he is depressed, as
physical limitations prevent him from running
marathons. As such, you provide suggestions
for running groups with individuals in his age
category, as well other groups that may be a
good fit for him, in addition to psychotherapy.
An example of this same scenario that may not
be consistent with intersectionality is to assume that the depression of the elderly patient
must be due to homesickness and suggest that
he continue a course of psychotherapy primarily focused on addressing depression for homesickness. This example inappropriately ascribes
certain characteristics to group members.
Reconceptualize the feedback session. Consider
the feedback session and recommendations
as clinical tools that serve to address multiple
discriminations and systemic oppression. As
a result of intersectionality, individuals may
be pushed to the margins and experience profound discriminations, while others may benefit from a privileged position as a result of their
intersectionality. A clinician can advocate for a
patient who prefers in-home cognitive rehabilitation, in the language of their choice simply
by adding it to the recommendations. Although
certain services may seem unattainable or may
not be the normative mode to receive such services, consider including it and an explanation
for the need. This gives patients a voice and also
sends the message that this patient is worthy of
having their request carefully considered.
References
AWID. (2004). Intersectionality: A tool for gen-
der and economic justice. Women’s Rights
and Economic Change, 9, 1-8.
Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist
critique of antidiscrimination doctrine,
feminist theory, and antiracist politics.
University of Chicago Legal Forum, 139–67.
Gorske, T. T. & Smith, S. R. (2009). Collaborative
therapeutic neuropsychological assessment.
New York, NY: Springer Science + Business
Media
Ontario Human Rights Commission (2001). An
intersectional approach to discrimination:
Addressing multiple grounds in human
rights claims. Discussion Paper, Policy and
Education Branch.
Postal, K. & Armstrong, K. (2013). Feedback
that sticks: The art of communicating neuropsychological assessment results. Oxford:
University Press
Dr. Kimberly L. Smith is a clinical neuropsychologist.
She is currently at Cedars Sinai Medical Center in
the Department of Neurology and has a thriving
part-time private practice in forensic neuropsychology in Beverly Hill, California. Her passion is understanding the differential expression of neurodegenerative disorders among underserved populations,
and the identification of neurobehavioral assessments and potentially promising treatment interventions for translation into patient care. Dr.
Smith is serving a three-year term as the Education
Representative on the Committee for Early Career
Psychologist, where she passionately advocates for
ECPs across all subfields of psychology concerning
licensure, educational opportunities, and career
development.
S/ECP Virtual Learning Hour —February 12; 2:30 PST
The first learning hour for S/ECP will be hosted Stephanie Mihalas in conjunction with our guest speaker.
Ms. Carolyn Cowl-Witherspoon.
Ms. Cowl-Witherspoon is a graduate student in general psychology at Walden University. Ms. Cowl-Witherspoon’s areas of academic focus are religious privilege, anti-Semitism, microaggressions, bullying, multiculturalism, ethics, and social justice. Some of her long-range goals include assisting others, through compassionate and
pro-social education and representation, in recognizing the negative consequences which may result from the
systemic religious subordination or derogation of minority religions, spirituality, and nonreligious beliefs, as well
as the unintentional marginalization of their cultural ideologies and practices.
Visit the Division 42 website for further information and the call-in number.
Winter 2016
13
Focus on Clinical Practice
The Power of Possessions in the
Family Inheritance Drama
Steven Hendlin
A
s the Baby Boomer generation now
confronts the death of their parents,
the financial inheritance drama around money
and possessions is being played out by siblings
and other family members with an emotional
fury and vengeance that is sometimes powerful
enough to sever their life-long relationships.
It was because of how often I heard patients
complain about broken relationships that over
a decade ago, I wrote the first book focused on
the psychology of preserving relationships and
transferring possessions preceding, during, and
after an inheritance event (Hendlin, 2004).
When you consider it from the point of view of
the sibling relationships at risk, it is remarkable
that the interest in inheriting possessions from
a parent can mean so much. The history of families through generations shows us repeatedly
the price some will pay just to have a material
object. And typically, the possessions that are
fought about most are of sentimental but limited monetary value.
The price we are willing to pay is this: we will
make the possessions more important than our
relationship with our blood relatives—those to
whom we have often have felt the closest and
with whom we have shared some of the most
significant events of our lives. We may not
admit that we will risk our relationships over
possessions, but for those who won’t compromise and where resentments from the past take
over to dictate their behavior, this is exactly
what is at stake.
Even when we don’t covet the object itself, our
primitive fear of losing out on something or
being taken advantage of by sibs may take over.
14
This impulse may lead to getting caught up in
arguments over objects simply as a defensive
maneuver not to be taken advantage of by sibs.
This is why understanding how we are playing
out past patterns is so important. If we aren’t
aware that we are reacting from issues from the
past, we will find ourselves feeling righteous
indignation. We may take a stand that threatens relationships over personal property of the
dying or dead parent that isn’t even desirable to
us and that we
don’t really even
want. But we
can’t stand the
thought that our
sibs may be getting something
we aren’t—just
as we couldn’t
when we were
children.
One of the key
insights in
understanding
the inheritance
drama is how power-fully our emotional past
with our sibs colors the inheritance process—and
especially the division of money and personal
property (Hendlin, 2004).
We will risk the future coherence of our family
because we believe we must have some object
that connects and bonds us to the parent who
has died. The object and the connection become more important than the real, live relationship we have with a brother, sister, uncle or
aunt. Greed and pettiness may rule over honesty, fairness, and a sense of integrity. And so we
re-enact the same childhood behaviors now as
adults that we used when young.
For example, we will go so far as to steal or hide
Winter 2016
objects that we want. We will lie to our sibs
about whether we have taken anything. And
we will justify our actions to ourselves anyway
we can so that we don’t feel guilty. We may
even invoke the dead parent, believing, “Mom
wanted me to have this gold watch” to justify
lying, stealing or deceiving our sibs and other
relatives. We may end up at odds with a living
parent over something the dead parent promised to leave us but ends up in the hands of the
spouse.
Given the power of personal possessions to
create blood wars, it’s important to understand
why we are willing to risk relationships with
siblings and other family members over personal property. While it’s definitely true that
objects of a parent who dies help keep us connected, it is only this way because of the meaning we imbue to the objects and the association
we make between the object and the parent.
This is made very clear when you see how
differently siblings will value a particular item.
While some items may be equally of interest to
all sibs, many have a particular meaning and
value associated to them that will vary from
child to child. While this may seem obvious, the
reality of how it operates during the division of
property is sometimes quite striking.
For example, there may be many items of a
father that your sibs find to be of interest and
value, while you may have no interest at all.
The fact that it is your father’s guitar does not
necessarily mean that you are interested in
owning it. But as to those items you are interested in, you are attributing value to them
mostly because of the associations they held for
you or the experiences you’ve had with them.
Because we may be connected to the parent
through photographs, letters, e-mail, and our
complete memory bank of experiences with
him or her, there is no one specific object alone
that is going to connect us forevermore.
No matter how many of the parent’s possessions we have, there may be an unconscious
fear of forgetting him, of losing the mental
image that we want to be able to recall at any
moment. Despite having pictures, as time passes, some are afraid they will lose their sense
of the “essence” of the parent. So they may
want a bottle of perfume, clothes that have the
perfume smell of the mother, a father’s pipe
tobacco pouch, or anything that may be used to
reinforce the memory so that they don’t forget
their literal sense of the person.
I know this fear of forgetting the parent is true
because I’ve heard it expressed by patients over
the years in my clinical practice. Sometimes it
is only a matter of months after the loss, and
they are already fearful of forgetting the mannerisms and impact of the loved one. Some
will say, “I’m afraid of forgetting my mother’s
face.” Children and adolescents express this
fear very directly, as their storehouse of memories and ability to call on them is more limited.
For adults, the stronger the attachment to the
parent, the less likely they are to worry about
losing the image.
We need to remember that as we negotiate
with our siblings during the process of dividing
personal property, the objects themselves are not
what really matters. We can decide how little
or how much we need to keep us connected to
a parent. And this means that we can always
compromise with a sibling for the sake of the
future of our relationship—without feeling
that something vital to our life is being given
up just because we may not end up with what
we want.
Again, no matter how valuable we may deem it,
possessing any particular item is not necessary
to the survival of our images and memories of
the parent. So we can use the process of dividing personal property as an opportunity to give
to our sib what she cares about more than we
do. We may do this in the service of going past
our own desires for the sake of feeling a closer
bond.
One of the problems that arises when there are
life-long sibling rivalries is that it is tough to
switch gears and stop competing for the parent’s possessions. With highly competitive
siblings, it is easy to make the division of possessions a contest, each doing their best to get
Winter 2016
15
the “best” objects and not wanting to see a sib
end up with something that they want. Instead
of thinking longer term, it’s easy to lapse into
the mentality of “getting my share,” not being
generous or even thoughtful of the other when
it comes to letting a sib have something which
may be more meaningful to her than it is to us.
But when we are aware of our tendency to get
caught in the competitive aspect of the division
of property, we may consciously decide to make
decisions which result in closeness rather than
distance. Or, at least, decisions that don’t push
us any further away.
The Need for Nurturing and Hunger for
Possessions
Why do we find it easy to get greedy, hungering
for the parent’s possessions?
It is not just sibling rivalries that create the
competitive setting. What we need to understand is that the death of a parent re-awakens
early needs to be cared for, protected, and nourished by the parent. These needs are operating
whether or not we are conscious of them.
The adult child is confronted with the questions, “Who will protect me from the world,
now that you are gone?” and “How will I fill the
loss and emptiness that I feel?” This may be
especially powerful if we are dealing with death
of the last parent.
In facing and resolving these questions we fully
learn to stand on our own emotional feet, no
longer able to be soothed by our parents. This
is why some developmental psychologists have
maintained that we don’t fully stand on our
own emotional feet until our parents have died
and the buffer they have provided between us
and death is no longer in place to protect us.
And it is because of this fear of making our own
way in the world without the nourishment and
support from our parents that we may substitute inheritance money and real and personal
property to fill the emotional loss and emptiness. If we can use this insight as to one of
the roles possessions play during inheritance,
16
we can consciously decide that we will fill our
emptiness in another way. By doing that, we are
less likely to be grasping for the parent’s possessions.
For those who can adopt a long-term mentality,
a parent’s death is the perfect opportunity to
make up for past perceived inequities between
siblings and to set the foundation for a connected future. At least to some degree, it is our
siblings, spouse, children, extended family and
friends who may fill the emptiness that we are
feeling in our loss of the parent. As well, we
may find fulfillment in our work, hobbies, children and other interests that sustain us in life.
Since our common loss is what connects us
most deeply in dealing with the inheritance
drama, the process of mourning and grieving
may be made more manageable when siblings
consciously use the situation to support each
other emotionally. But this is only possible
when we focus more on the relationship to the
person than the relationship to the possessions
up for grabs.
In support of the above, in some families one
of the sibs—often the eldest but not always—
will step forward and begin to assume some
of the nurturing behaviors of the parent who
has died. For example, the eldest daughter will
begin to look after her sibs more closely than
she had before the death. She may consciously
or unconsciously take over some of the mannerisms, habits and nurturing behaviors of her
mother. Or the most nurturing brother may
begin to call his sibs more often to see how they
are doing in handling their grieving. Likewise,
he may begin to take on some of the protective
habits of his father.
The obvious but penetrating realization by the
sibs that “all we have now is each other” may
bring out a spirit of togetherness and cooperation that transcends the typical petty bickering that often accompanies the division of the
estate. It may draw sibs closer to the remaining
parent, if there is one. And it may heighten the
awareness, at least for awhile, that we don’t
have forever to spend time with our sibs and
other family members and so we ought to take
Winter 2016
advantage of what time we do have, actively
including them in our lives.
funeral and their feelings of loss.
Sometimes this awareness will lead to an interest in forging or renewing relationships with
extended family, such as distant aunts, uncles,
cousins and others. This interest may lead to a
sustained effort to stay connected. More often
than not, however, when everyone goes back
home to the far away cities in which they live,
it is easy for the connection efforts to be limited
or to fall away. But even if this occurs, the whole
family may still help each other through the
Reference
Hendlin, S. J. (2004). Overcoming the inheritance
taboo: How to preserve relationships and
transfer possessions. New York: Penguin/
Plume.
Steven Hendlin, Ph.D., has been in private practice
for forty years, presently in Newport Beach, California. He is a Fellow of Divs. 29, 32, and 42. He may
be contacted at www.hendlin.net.
From Research to Practice
Sara J. Giachino and Andrea Kozak Miller
Loneliness Interventions
The question of how best to assist clients
in reducing loneliness is a treatment concern faced by most psychologists. Cacioppo and colleagues expanded on a previous
meta-analysis by Masi et al. by reviewing
the efficacy of loneliness treatments and
providing suggestions for future integrative
treatment models with a focus on targeting maladaptive social cognition. As a risk
factor for psychological problems and physical health issues, they assert there is a great
need to identify effective treatment methods
for loneliness. The aforementioned Masi et
al. meta-analysis revealed of the four general types of loneliness interventions (social
support-based, increasing opportunities to
socialize, social skills training, and addressing maladaptive social cognitions), interventions that focused on challenging maladaptive social cognitions had the largest mean
effect size (-.598). Cacioppo and colleagues
offered a model of three components of
loneliness based on social and attentional
spaces which helped to explain “sources of dysfunctional and irrational beliefs,
false expectations and attributions, and
self-defeating thoughts and interpersonal
interactions” (p. 245). Based on the model,
the authors suggested an intervention for
loneliness might include components such
as education on mindfulness, capitalization,
empathy, perspective-taking, identifying
negative thoughts related to others and
social situations, and challenging negative
thoughts. They further offered that animal
studies have provided promising evidence
of possible future adjunct pharmacological
treatments to address the neurobiological
impact of social isolation such a selective
serotonin reuptake inhibitors (SSRIs), neurosteroids, or oxytocin. Clinicians might be
interested in the full reprint of the article
for further detail on interventions to reduce
loneliness.
Cacioppo, S., Grippo, A. J., London, S., Goossens,
L., & Cacioppo, J. T. (2015). Loneliness: Clinical import and interventions. Perspectives on
Psychological Science, 10(2), 238-249. Reprint
requests to Stephanie Cacioppo at scacioppo@
bsd.uchicago.edu.
Social Media and Body Image
Understanding of the psychological impact
of social media is still in its infancy. Fardouly et al. examined how Facebook-based
social comparisons impacted women’s
body image and mood. Participants in the
study were 112 women, ages 17-25, who
were randomly assigned to one of 3 Internet browsing conditions (the website of a
fashion magazine, personal Facebook page,
or a website deemed neutral with regard to
Winter 2016
17
appearance as a control). Participants were
told they were part of a study on memory
and the media. Before and after 10 minutes
of browsing, participants completed visual
analog scales for state negative mood and
body dissatisfaction. In addition, participants completed the Self Discrepancy Index
(SDI) to measure appearance discrepancies
and the Upward and Downward Appearance
Comparison Scale to assess social comparison. Hierarchical multiple regression analyses were employed to examine the impact
of website exposure on negative mood, body
dissatisfaction, appearance discrepancies,
and to explore the potential moderating
effect of trait comparison tendency. Results
showed participants in the Facebook condition acknowledged a more negative mood
than those in the control condition. For
women assigned to the Facebook group who
were also high in appearance comparison
tendency, they endorsed more hair, skin,
and facial discrepancies as compared to the
control group. The prediction that Facebook
and fashion magazine browsing would lead
to increased body dissatisfaction was not
supported in the analyses. These preliminary results suggest the value in clinical
work of inquiring about Facebook use in
terms of gaining insight into negative mood
states as well as the usefulness of working
to understand client appearance comparison tendencies in clients who use Facebook
as a potential contributor to body image
concerns. Clinicians might be interested in
in reading further about the study and the
potential clinical implications.
Fardouly, J., Diedrichs, P. C., Vartanian, L. R.,
& Halliwell, E. (2015). Social comparisons on
social media: The impact of Facebook on young
women’s body image concerns and mood. Body
Image, 13, 38-45. Reprint requests to Jasmine
Fardouly at [email protected].
Family Intervention for Childhood Cancer
As practitioners become more integrative in
practice, we are faced with the complexities
of addressing the psychological impact of
serious health concerns within the family.
As part of a larger research project, West et
al. examined a family systems intervention
to address loss of normalcy in families cop18
ing with childhood cancer. Three families
were included in the research for a total of
16 family members, including 3 children
diagnosed with cancer. All family members
participated in a video-recorded relational
family systems intervention implemented
by nurse clinicians derived from the Illness
Beliefs Model or IBM aimed at decreasing
family illness suffering. Six of the 16 family members also participated in research
interviews. Additional data was collected
from clinical records and letters related to
the clinical work. Part of the intervention
highlighted by the authors included nurses
“[receiving] the illness testimonies shared
by family members,” (p. 275) and providing
new interpretations of experiences of suffering by way of a clinical reflecting team.
Qualitative/hermeneutic analyses revealed
that suffering relayed by family members
was related to loss of normalcy within the
family and a desire to return home. The
therapeutic conversations led by nurse
clinicians with a purpose of eliciting conversation within the family about illness suffering and the interpretations provided by the
reflecting team are described as “relevant
and healing interventions” (p. 270) for reducing suffering. Participants identified the
value of nurses in the intervention attending to strengths of the family and individual
members in addition to discussing losses
related to illness. West el al. offer that this
type of intervention can be implemented by
two or more interdisciplinary team members willing to meet with family members
impacted by childhood cancer to discuss
family illness suffering and offer new interpretations on which family members can
reflect. Clinicians might consider this information in their work on interdisciplinary
teams. Individuals might be interested in a
reprint of the article for additional information on the family-based intervention.
West, C. H., Bell, J. M., Woodgate, R. L., & Moules,
N. J. (2015). Waiting to return to normal: An
exploration of family systems intervention
in childhood cancer. Journal of Family Nursing, 21(2), 261-294. Reprint requests to Christina West at [email protected].
Winter 2016
Trauma and Workers Compensation
We often work with individuals who experience post-traumatic stress disorder (PTSD).
Individuals who experience work-related
trauma may experience PTSD and other
mental health concerns. Use of Workers
Compensation (WC) is connected to on the
job injuries, including injuries which result
in PTSD and other mental health diagnoses. Wise and Beck reviewed both federal and state WC statutes which examine
physical-physical injuries, physical-mental injuries, mental-physical injuries, and
mental-mental injuries with the first in
the string causing the second. Wise and
Beck found a broad range of WC coverage
related to trauma exposure in the work
setting. Interestingly, only 40% of states
cover mental-mental injuries via WC while
100% cover physical-physical injuries. With
the lack of coverage for treatment of mental-mental injuries it is possible to extrapolate out to possible loss of productivity and
quality of life. Wise and Beck note that WC
is sometimes a first line of coverage prior to
seeking out other types of assistance. They
suggest reform of WC to better cover mental
health needs of individuals who experience
work-related trauma. Practitioners might be
interested in the full reprint of the article for
additional information on state by state and
federal variance in WC coverage.
Wise, E. A., & Beck, J. G. (2015). Work-related trauma, PTSD, and workers compensation
legislation: Implications for practice and policy.
Psychological Trauma: Theory, Research, Practice,
and Policy, 7(5), 500-506. Reprint requests to
Edward A. Wise at [email protected]
Chronic PTSD
At times we work with individuals with
chronic mental health conditions, such
as chronic Posttraumatic Stress Disorder
(PTSD). Bedard-Gilligan et al. explored
characteristics of individuals in a treatment
trial for chronic PTSD. While there are many
studies on treatments for PTSD, there is a
gap in the research examining randomized
controlled trials for individuals with complex cases including comorbidity. A sample
of 200 individuals were studied with specific inclusion and exclusion criteria detailed,
including items such as a PTSD primary diagnosis, no current psychotic diagnosis, and
no current substance dependence diagnosis.
Data were gathered via a demographic interview, trauma history, and treatment history
as well as completion of the PTSD Symptom
Scale-Interview (PSS-I), Hamilton Rating Scale
for Depression (HRSD24), Structured Clinical
Interview for DSM-IV (SCID-IV), Sheehan
Disability Scale (SDS), and Dissociative Experiences Scale (DES). Within the sample the
authors “found high rates of comorbidity,
multiple trauma exposures, prior treatment
seeking, impaired functioning, and dissociation” (p. 732). Individuals with both PTSD
and Major Depressive Disorder had greater
numbers of overall diagnoses, higher levels
of dissociation, higher levels of past treatment, greater severity of symptoms, and
lower levels of functioning. Individuals who
experienced trauma as children and individuals who experienced trauma as adults
scored similarly on measures which differed
from past research which typically indicates
trauma from childhood as being related to
increased severity of symptomatology and
poorer functioning. Individuals who experienced multiple traumas reported more
severe symptoms of depression. Clinicians
might be interested in the full reprint for
the detailed review of all variables examined and their relationships with severity of
symptomatology.
Bedard-Gilligan, M., Duax Jakob, J. M., Stines
Doane, L., Jaeger, J., Eftekhari, A., Feeny, N.,
& Zoellner, L. A. (2015). An investigation
of depression, trauma history, and symptom severity in individuals enrolled in a
treatment trial for chronic PTSD. Journal
of Clinical Psychology, 71(1), 725-740. Reprint requests to Michele Bedard-Gilligan at
[email protected]
Winter 2016
19
Friends with Benefits
Dana Charatan
G
iven the ubiquity around money matters in the clinical situation, there seems
to be a dearth in the psychoanalytic literature
about the relational and symbolic aspects
of money. While certain authors have taken
some initiative in discussing relational theories about money in treatment (Dimen, 1994;
Hirsch, 2008; Josephs, 2004), generally speaking, this arena remains largely undertheorized
and discussed. Perhaps resultantly, graduate
clinical psychology programs consistently fail
their students in their lack of preparation to
enter the world of private practice. The disconnect between training programs foci coupled with the fact that a significant number of
graduates will eventually spend at least part of
their professional lives as private practitioners
(United States Department of Labor, 2011)
does a disservice not only to these professionals-in-the-making but also to their subsequent
patients. Typically, psychology students complete their pre-doctoral trainings in settings
where the exchange of a fee for service is not
part of their responsibilities. Therefore, upon
finishing graduate and/or postdoctoral training
and entering into independent practice, the
collection of a fee and its myriad vicissitudes
are often new and startling territories for the
early career professional to navigate (Shields,
1996). Because, by definition, private practice
commoditizes the therapeutic relationship
(Cushman, 1995), the financial arrangement
between therapist and patient become a salient,
yet all-too-often undiscussed, analytic third.
Over the course of graduate training, students
develop a sense of themselves professionally
in numerous ways: academic, trainee, intern,
post-doc, and ultimately, practitioner. Yet, one
aspect of self that appears to be vastly underdeveloped is that of self-as-entrepreneur. Most
therapists are hesitant to state that they prioritize earning money as a main objective in their
work (Bass, 2007; Kreuger, 1991; Myers, 2008;
Weissberg, 1989). As a collective, clinicians
20
are not business savvy, and are more likely to
report passion about our work rather than that
interest in cultivating wealth. Zeal for one’s professional undertakings is not to be discarded or
discounted, but neither is the healthy desire to
earn a reasonable living in one’s field of choice.
However, the qualities that
likely make for a good analyst (caring, empathic, supportive, nurturing) seemingly conflict with those
that have been traditionally
construed as being successful in business (ruthless,
ambitious, cutthroat). I suggest that this schism is a major contributor to
the ineptitude that academic programs possess
in training their students to create a sense of an
entrepreneurial self. (It is also noted that many
doctoral training programs are large-scale
for-profit organizations [Norcross & Sayette,
2011]. Thus, we could describe a kind of macrosystemic parallel process that occurs when
doctoral students collect as much as hundreds
of thousands of dollars in debt to enter a career
in which there is no guidance as to how to create a smaller-scale financially solvent business.)
How do we as clinicians, particularly in the
early stages of our careers, develop a sense of
personal agency around our need and wish to
earn respectable incomes for our rather difficult
and at times emotionally draining work?
Many therapists describe feeling guilty about
collecting fees for their services (Myers, 1998).
How can we ask our patients to bare their souls
to us, weep about their childhood scars, share
with us their darkest, most intimate fantasies-- secrets they often tell no one else in their
lives, not even their spouses, lovers, parents,
or closest friends--and then at the end of the
session or the month, hand them a bill for our
time? Personally, I know many clinicians who
consciously and unconsciously communicate
to their patients that their time is not worth
very much, or that the exchange of money for
therapy services is a “dirty secret” that cannot
be explored or discussed. The discomfort with
money is exemplified by a colleague who asks
her clients to write a check after each session
and stick it in a manila envelope outside her
Winter 2016
door, as if the therapy room would be “tainted” should the check enter the room. Another
instance involves a therapist who hands her
patients an envelope at the beginning of each
session, asking them to place the check inside
before they begin. Can she not touch the check
as it is being handed over to her by her patient,
a shared intersubjective acknowledgment that
therapy comes at a price? A peer describes his
therapist’s ritual as she hands him his bill each
month along with an apology. What is being
communicated here? How can we implore our
patients to adopt a stance of self-esteem and
value what they have to offer to others in their
lives, as well as what they can receive from
those same individuals, when we implicitly deliver the message that we ourselves do not prize
our own professional self-worth?
The examples I described above do not discriminate between age, gender (although it is well-researched that men tend to set higher fees for
their clinical services than do women and are
less willing to slide their fees, or at least admit
to so doing [Dimen, 1994]), degree, or years in
practice. Further complicating the issue is the
continuously constraining managed mental
health care system that perennially seeks to
limit both the scope and depth of services provided to its members. I propose to explore the
meanings within the dyad in the negotiation of
setting a fee, billing, and collecting money, particularly as it relates to individuals at the beginning stages of their careers. I believe that I come
from a privileged position as a recent graduate in
a state in which one can walk out of internship
and enter directly into private practice, along
with the fortune to have been able to transfer
several patients from my internship (where we
did not exchange money directly) to my private
practice. In this new environment, concerns surrounding my fee have often led to meaningful
explorations of how issues around money can
impact the analytic relationship. As money has
shifted from being a nameless, faceless entity in
the therapeutic dyad to being an integral aspect of the analytic relationship, emotions have
emerged surrounding both my patients’ feelings
about their own self-worth and my beliefs about
my own personal and professional value. Furthermore, if left unexplored and unprocessed,
issues related to fees can become fertile ground
for enactments, entanglements, and relational
knots (Bass, 2003; Hirsch, 1987; Nahum, 2008;
Pizer, 2003). I offer the following clinical vignette in order to illustrate these dynamics and
the various ways in which they might play out in
treatment.
Amy
Amy and I started our work together while I
was approximately seven months away from
completing my pre-doctoral internship. She
was relying on loans as well as a part-time job
to help pay for her studies. Amy had lived in
several different countries as well as various
areas of the US, including nations with a single-payer health care system in which she received therapy for free. Having experienced an
extensive abuse history, she had received years
of therapy mandated by child services, also
for which no exchange of money transpired.
Having been a patient in at least three different
countries, and being biracial, she had a wealth
of knowledge about cultural implications for
relationships in general and therapy in particular. Her main complaint with previous clinicians was their tendency to blame her mother
for everything, a stance with which she had
grown weary.
And so we began our work together. While depression and anxiety were her initial presenting
concerns, finances quickly came to the fore of
our sessions. I learned that although she was almost 30, she continued to reside at home with
her mother, who lived an hour-long commute
from campus. Given her age, employment,
access to loans, and availability of affordable
housing closer to campus, I questioned Amy as
to why she had not moved out. It was then that
I learned that her mother was wickedly verbally and emotionally abusive to Amy. Of course,
this revelation led me to inquire further why
she was still living at home. Amy replied that
she could “put up with” the behavior because of
the money she was saving on rent and therefore
could imagine someday having a “really nice”
place of her own.
As my internship was nearing its conclusion,
Winter 2016
21
and I was starting to think about transferring
cases, it was also becoming known to me that I
lived in a state in which I could go straight into
private practice, my dream job. My internship
was supportive of me evaluating on a caseby-case basis who might be able to come with
me based on attachment, feasibility to attend
therapy off-campus, proximity to graduation,
and ability to pay. I knew Amy would not be
able to afford my fee, yet I also was aware that
our working relationship was the longest one
she had ever experienced. I offered to see her at
half my rate, given the fact that she was working and had few expenses. Amy stated that she
could not afford this sum, and we began to discuss a transfer to my supervisor. It was at this
time that her severe depression re-emerged,
ultimately leading her to take a semester off
from school. Terrified and guilty, I agreed to
see her for ten dollars. She quickly agreed, and
within a week her depression seemed to have
substantially remitted. Quickly after entering
my private practice, we agreed to meet twice
a week for five dollars. While I was relieved to
see her faring better emotionally and gratified
to get to do more depth-oriented work, a more
sinister side of me felt far less benevolent. I felt
somewhat played. Within a month, Amy asked
for another session a week, and again I experienced a conflation of eagerness and irritation.
Each month when I would give Amy her bill,
she would express guilt and shame that she
was paying me so little. I would explore these
feelings with her, feelings that were very old
for her, and offer her the possibility that I was
in fact benefitting from our time together
beyond monetary gains. In fact, I rationalized
for myself that I was indeed getting something
from our sessions: I was getting to work “analytically.” This pattern continued until one day
when Amy reported to me that medical bills
she had been paying off were finally paid in full.
Instantly, something clicked: Amy was on the
university insurance plan, a plan which would
cover half of her sessions with me. I noted that
she had an insurance plan for which she was
paying but not fully utilizing. Amy stated that
she was too “ashamed” to submit her five dollar
sessions for insurance. I shot back that five
dollar fees were for people who did not have
22
access to insurance. As soon as I said it, I felt
awful, but I also realized that I was colluding
with her reflexive belief that not only would
she be “shamed” by others for asking for help,
but also in blocking her ability to experience
agency in paying for a service that she could in
fact pay much more for than either one of us
had initially believed. Furthermore, in fear of
being another castigating therapist who was
not worth paying for seeing, I allowed myself
to feel played, denying myself the experience of
being somewhat appropriately paid for what I
knew to be good work. Once the dialogue was
opened, Amy calculated that she could actually
pay eight times per session what she had been
paying me. I was both flabbergasted and exuberant. Furthermore, after raising her fee, Amy
came much more alive in the treatment, active,
questioning, noticing of my subjective experience (Aron, 1991), and much more willing to
examine the ways in which we both contributed to the dynamics in the room. We continue
to work through her long-ingrained patterns of
shame and guilt, but they have become much
less reflexive and far more open for exploration.
Conclusion
I have subsequently raised my fee three times
since entering practice: once upon getting
licensed as a psychologist, again after entering
analytic training, and once more to a fee that
places me toward the higher end of the market
in my area. The reactions I have received are
as unique as each one of them and our relationships to one another are. While some have
complained, and I have also lowered my fee for
others when necessary, the most common response has been an understanding of the need
to stay current with cost of living, and several
patients (or patients’ parents) have even said
they were happy for me. I imagine part of that
is the internalized sense that my self-worth,
as seemingly determined by my fee, is inextricably tied to their own feelings of self-esteem.
In a capitalist society such as the one in which
we live, and as members of the “professional-managerial” class (Ehrenreich & Ehrenreich,
1979; Ehrenreich, 1989), therapists are left to
equate our value in terms of what services we
have to offer others. Because psychoanalytic
Winter 2016
work is essentially subjectively defined, how do
we make meaning of our worth if not through
our fee, how full our hours are, and how many
patients see us for our full fees? In a profession in which the conceptualization of “goods”
is inherently based on our skill, and our skill
is often unknowable to us during any given
clinical encounter, we become forced to rely on
a commoditized sense of our professional, and
hence personal, value. This problem is further
complicated by our field’s refusal to train us as
entrepreneurs, leaving us to sort through our
feelings of guilt, dissonance, dirtiness, and ultimately secrecy about the success or weaknesses of our practice. As Freud (1913) observed,
“Money matters are treated by civilized people
in the same way as sexual matters -- with the
same inconsistency, prudishness, and hypocrisy,” (p. 131). It appears little has changed in the
century that has transpired since this remark.
How many of us have been curious to know
how full our colleagues’ practices are, or what
rate they charge, but feel it is impolite to inquire? As early career practitioners, these
anxieties are heightened by fears that we will
be unable to pay back student loans, start-up
costs, and essentially fail to find our way to the
good life that we want for ourselves as much
as we do for our patients. I believe that there is
nothing inherently wrong in wanting to be paid
for one’s time, knowledge, and skill. Yet when
faced with the impostor syndrome (Clance &
Imes, 1978) experienced by most recently graduated clinicians, along with the paradoxical
nature of being in the “helping” profession, or
as Klebanow (1989) refers to it the “impossible
profession,” (p. 322), while avowing the fact
that such help indeed comes at a price, it becomes easy to move towards shame and guilt.
Our society’s complicated relationship with
money as explicated by recent macroeconomic
events does little to assuage such discomfort.
However, by acknowledging the tension between the at times inherently opposing needs
of patient and analyst (Hirsch, 2008; Slavin &
Kriegman, 1998), we can begin to explore such
tension, make meaning of it, and if not completely work through it, at least gain enough
comfort so that money need not be a “dirty
little secret,” the unspoken analytic third in
the room. Symbolic and relational meanings
of fees, payments, class status, and other taboo topics can be opened up and addressed. By
allowing space for our patients to notice and
address our own subjective experience (Aron,
1991) around money, perhaps they can begin
to initiate discussion of other previously foreclosed upon arenas. Psychoanalysis is at its best
when it elevates discourse to a level heretofore
experienced as impermissible. If we want to ask
our patients to speak freely about their areas of
shame, we ought to be willing to do the same.
Money, and its acquisition through emotional
and relational engagement, seems as good a
place to start as any.
REFERENCES
Aron, L. (1991). The patient’s experience of the
analyst’s subjectivity. Psychoanalytic Dialogues, 1, 29-51.
Bass, A. (2003). “E” enactments in psychoanalysis: Another medium, another message. Psychoanalytic Dialogues, 13, 657-675.
Bass, A. (2007). When the frame doesn’t fit the picture.
Psychoanalytic Dialogues, 17, 1-27.
Clance, P.R., & Imes, S.A. (1978). The impostor
phenomenon in high achieving women: Dynamics and therapeutic interventions.
Psychotherapy: Theory Research and Practice, 15, 241-247.
Cushman, P. (1995). Constructing the Self, Constructing America: A Cultural History of Psychotherapy. Reading, MA: Addison-Wesley.
Dimen, M. (1994). Money, love, and hate: Contradiction and paradox in psychoanalysis. Psychoanalytic Dialogues, 4, 69-100.
Ehrenreich, B. & Ehrenreich, J. (1979). The
professional-managerial class. In P. Walker
(Ed.), Between Labor and Capital (pp. 5-48).
Boston: South End Press.
Ehrenreich, B. (1989). Fear of Falling: The Inner
Life of the Middle Class. New York: Pantheon.
Freud, S. (1913). On beginning the treatment.
In J. Strachey (Ed. & Trans.), The Standard Edition of the Complete Psychological Works
of Sigmund Freud (Vol. 12, pp. 123-144). London, The Hogarth Press, 1958.
Greenson, R.R. (1967). The Technique and Prac-
Winter 2016
23
tice of Psychoanalysis: Vol. 1. New York: International Universities Press.
Hirsch, I. (1987). Varying modes of analytic
participation. The Journal of the American
Academy of Psychoanalysis and Dynamic
Psychiatry, 15, 205-222.
Hirsch, I. (2008). Coasting in the Countertransference: Conflicts of Self Interest between
Analyst and Patient. New York: The Analytic Press.
Josephs, L. (2004). Seduced by affluence: How
material envy strains the analytic relationship. Contemporary Psychoanalysis, 40,
389-408.
Klebanow, S. (1989). Power, gender, and money.
The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 17,
321-328.
Kreuger, D.W. (1991). Money meanings and
madness: A psychoanalytic perspective.
The Psychoanalytic Review, 78, 209-224.
Myers, K. (2008). Show me the money: (The
“problem of”) the therapist’s desire, subjectivity, and relationship to the fee. Contemporary Psychoanalysis, 44, 118-140.
Nahum, J.P. (2008). Forms of relational meaning: Issues in the relations between the
implicit and reflective-verbal domains:
Boston Change Process study group. Psychoanalytic Dialogues, 18, 125-148.
Norcross, J.C. & Sayette, M.A. (2011). Insider’s
Guide to Graduate Programs in Clinical and Counseling Psychology. New York: The Guilford Press.
Pizer, B. (2003). When the crunch is a (k)not: A
crimp in relational dialogue. Psychoanalytic Dialogues, 13, 171-192.
Racker, H. (1957). The meanings and uses of
countertransference. Psychoanalytic Quarterly, 26, 303-357.
Shields, J.D. (1996). Hostage of the fee: Meanings of money, countertransference, and
the beginning therapist. Psychoanalytic
Psychotherapy, 10, 233-250.
Slavin, M.O. & Kriegman, D. (1998). Why the
analyst needs to change: Toward a theory
of conflict, negotiation, and mutual influence in the therapeutic process. Psychoanalytic Dialogues, 8, 247-284.
Slochower, J. (2011). Analytic idealizations and
the disavowed: Winnicott, his patients,
and us. Psychoanalytic Dialogues, 21, 3-21.
United States Department of Labor. (2011).
Bureau of Labor statistics, occupational
outlook handbook, 2010-2011, http://
www.bls.gov/oco/ocos056.htm, accessed
October 27, 2011.
Weissberg, J.H. (1989). The fiscal blind spot in
psychotherapy. The Journal of the American Academy of Psychoanalysis and Dynamic
Psychiatry, 17, 475-482.
Dr. Dana Charatan is a clinical psychologist in private practice
Boulder, CO and a member of Division 42. She is a third year
candidate in contemporary psychoanalysis at the National
Training Program of the National Institute for the Psychotherapies in New York City, New York. In addition, she is currently
the Secretary of Division 39 of the American Psychological
Association (Division of Psychoanalysis), and is an active
member of several of the division’s committees. Dr. Charatan
has taught, supervised and served as the Training Director for
the Boulder Institute for Psychotherapy and Research, and
currently serves as the Chair of its Front Porch Lecture Series.
Lastly, she is a member of the Denver Psychoanalytic Society
and a member of its Program Committee.
April 29-May 1, 2016
Registration information will be available on the Division 42 website at www.division42.org
24
Winter 2016
Focus on Business of Practice
Growing a Group Practice in the
Face of Healthcare Reform
Samantha Slaughter
A
few years ago, I realized that the business practice of psychology for which I
was trained was not the same practice in which
I was actually engaged. By this, I mean that
graduate school taught me how to be a psychologist in a world where private pay clients were
available and managed care was a behemoth
best avoided. However, when I started my solo
practice in 2009, I heard time and again from
potential clients, “I can barely afford my copay” due to the financial strain of the recession.
I soon realized that few clients could afford to
pay out of pocket. The advice I received when
opening my practice was to present to local
community centers (e.g., churches, schools) to
obtain a practice base. However, I found this
advice was no longer applicable. I could give all
the presentations I wanted, but if the potential
clients at these presentations could not afford
my fees, how could I keep my practice going
and make a living? I needed to build my practice quickly and in a way that made financial
sense to me. Insurance companies and managed care began to look like opportunities for
practice growth rather than behemoths to overcome. While I knew this meant accepting lower
than my full fee, I decided it was a tradeoff I
was willing to accept in order to pay my student debt and to build my practice. My practice
grew when I made the decision to credential
with various insurance companies, which
unknowingly set me on the road to building a
group practice.
Another way in which my graduate school
training did not match my real world experience was the type of practices that were available to me. I started with a solo private practice,
but within a year or two I began to attend conferences in which co-location, integrated care,
and affordable care organizations (ACOs) were
discussed regularly. Not once in my education
or post-doctoral training did I ever hear about
group practices and how to start and run them,
other than the occasional commentary such as,
“A group practice is a good place to start due to
the built-in referrals.” There was no way to pre-
dict that group practices might be the future of
psychological practice and that the knowledge
of how to create and run them could be useful
to my generation of psychologists.
In 2012, I became APA’s Federal Advocacy Coordinator for Washington State, which required
attendance at the APA Practice Organization’s
annual State Leadership Conference (SLC). SLC
provided a different stance on the potential
future of practice. Through discussions of the
Affordable Care Act (ACA) and the inclusion
of mental health as one of the ten essential
health benefits that insurance companies had
to provide in the plans they offered through
the federal and state exchanges, I began to fully
Winter 2016
25
comprehend the changing nature of the world
in which I was practicing. The message implied
that psychologists would have the chance to be
a part of a systematic change in our healthcare
system, allowing us to play a role in the leadership of healthcare’s future. SLC also affirmed
the unique skill sets that psychologists afford to
the conversation of integrated care.
The messages were clear that I needed to make
changes in the business of my practice. While
solo practice would likely always have a place in
the field of healthcare, group practices focusing
on integrated care with measureable outcomes
seemed poised to be a large piece of the future
practice of psychology. I wanted to find a way
to be in charge of my future instead of waiting
for healthcare change implementation, so I
decided to start a group practice. I believe that
establishing a group practice allowed me to act
on the knowledge I gathered from SLC, APA,
and other conferences about the business of
psychology and build a place in the future of
healthcare.
I initially was quite jealous of any psychologist
who was within five or ten years of retirement
as I assumed they would not have to face the
changes in healthcare systems. I fantasized riding out the changes and closing my practice as a
solo clinician. However, I had to face the reality
that the practice of psychology was predicted
to change significantly over the course of my
career. I needed to make a plan for the changing
landscape of psychological practice. At the time
that all of these events and thoughts occurred,
it was 2010; I was two years post-graduation
and working as the assistant director of a training site in addition to having a full-time private
practice. Again, joining the training site was
another fortuitous happening that added to my
foundation to be capable of opening a group
practice as I learned the business aspects of
group practice, making mistakes and learning
from them along the way. At one point, I managed 20 trainees across the training spectrum
(from practicum to post-doc), while at the same
time organizing continuing education workshops and preparing to review applications
from the next cohort. I learned how to hire and
26
to fire people, how to manage conflict, how to
organize and direct the many moving parts of
a system, how to interview potential trainees,
and how to stay sane all at the same time.
In the 2011 to 2012 academic year, my wife
was completing her graduate school and training as a physical therapist (PT). I discovered
through conversations the limited focus some
PT training programs have on a patient’s ability
to participate in treatment and in their overall
success when the patient had co-morbid mental health issues. We had many conversations
discussing the potential benefits of a mental
health clinician working collaboratively with
a PT. I longed for the chance to work collaboratively with a variety of medical providers, giving my clients access to a more integrated treatment approach. I recognized that there might
be a way for me to combine my strengths in
business administration with the need to take
charge of my future, a way that also allowed me
to offer a great service to my clients.
I decided to create a group practice – Integrated Psychological Services of Seattle (IPSS).
I launched IPSS in July 2015 after hiring a
post-doctoral trainee, another psychologist,
and my wife as our first medical provider. The
idea was to create an integrated group practice
of various specialty providers who are trauma-informed. This type of group practice is
not a novel model given the variety of specialty
clinics that provide integrated care (e.g., pain
management). However, IPSS differentiates itself compared to other specialty clinics because
mental health is the primary focus instead of
physical health. A physician does not oversee
treatment, but instead psychologist--working
collaboratively with the clients and medical
staff members on joint treatment goals.
In addition, the administrative skills I developed while the assistant director of a training
site are skills that I use every day in the group
practice. By interviewing training candidates,
I learned what qualities I want in future clinicians at IPSS. The daily running of the operations of the training site taught me how to stay
focused and organized in the management of a
group of providers. I also better understand the
Winter 2016
value of my own self-care and stress management, as well as how to encourage self-care in
others. As the CEO of IPSS, I continue to hone
these skills and to learn how to lead a group of
clinicians in today’s healthcare climate. I am
facilitating conversations so that we can define
what integrated care means to IPSS and how
we are going to collaborate treatment. I stay
aware of news that might impact the business
of psychology or our group practice and then
disseminate that information. Finally, I stay
connected to the pulse of IPSS, checking in with
clinicians regularly in order to give and receive
timely feedback.
IPSS makes a lot of business sense because I
no longer have to refer clients to others, due to
limited session availability. Once the current
clinicians carry a full caseload, I plan to hire
more psychologists in order to keep growing the
group. In addition, once the physical therapy
integration is successful, I plan to hire additional medical practitioners, eventually creating a
team of clinicians working together to improve
the lives of our clients. Keeping potential clients
within the group and expanding to offer additional services provides an additional revenue
stream other than what I bring in as a solo practitioner. I am also hoping that a large, diverse
group of providers who share a specialty area
will allow for the signing of contracts with various governmental agencies and to be eligible to
participate in ACOs or other opportunities that
will arise as the ACA implementation continues.
IPSS is still in its infancy. However, the mere
creation of the group practice gives me confidence that no matter what the future of practice holds, I will be ready to face the challenges,
offering a unique and innovative approach that
keeps me in the driver’s seat. In her keynote address for the 2012 SLC, Katherine Nordal, PhD,
APA Executive Director for Professional Practice, said, “If we’re not at the table, it’s because
we’re on the menu. And I quite frankly don’t
want to be on anybody’s plate to be eaten.” IPSS
is my seat. I welcome and encourage other early
and mid-career psychologists to think outside
of the box, creating their own seats at the table.
Dr. Slaughter is the CEO of Integrated Psychological
Services of Seattle. She has been in practice since
2009 providing psychotherapy and assessment
services. She is the Federal Advocacy Coordinator
for Washington State and on the Board of Trustees
for the Washington State Psychological Association.
Samathan may be reached at [email protected]
Early Career Psychologists
Self-Care Considerations for Early
Career Psychologists (ECPs)
Karin Lawson
E
arly career psychologists (ECPs) are still
getting to know themselves as full-fledged
working psychologists. Along with the euphoric feeling of healing depression, saving
marriages, and even saving lives, comes a host
of experiences most of us would rather do
without: feeling underappreciated, disputing
with insurance companies, and trying to stay
present, session after session, with clients who
are in profound pain. As practices and professional identities are developed, it is essential for
ECPs to simultaneously develop effective selfcare strategies. Inadequate self-care has been
frequently linked to caregiver burnout and
compassion fatigue (Figley, 2002; Weiss, 2004).
Research suggests that ECPs may be especially vulnerable to stress and burnout at work
(Skovholt & Ronnestad, 2003; Vredenburgh,
Carlozzi, & Stein, 1999). This burnout can
leave psychologists with a sense of emotional
exhaustion, depersonalization, and a reduced
sense of personal accomplishment (Maslach &
Goldberg, 1998).
Winter 2016
27
There are a lot of valuable self-care ideas out
there, but ECPs will quickly find that not every
shoe fits quite right for them. The notion that
we all need to turn it down a notch and chill
out is familiar: rest is crucial, recharging is
necessary, and serenity is invaluable. Articles on
self-care typically promote soothing and relaxing
strategies, though there is growing recognition
that sometimes we are revitalized by excitement,
newness, or risk-taking. Take a moment to consider your typical day (if you have one) and what
kind of interventions you could use. Do you find
that you need to boost your energy or soothe your
nerves, or perhaps a bit of both? The following
tips can help you improve your self-care whether
you need a lift or some relaxation.
Use your senses. To evaluate your own self-care
strategies, begin by checking in with the senses
and how they support you. In other words, what
ways do your sensory experiences energize or
calm your nervous system? Many psychologists
I speak with go for massages or mani/pedis, and
feel both relaxed and revived by the stimulation
of physical touch. Being outside in the sunshine
and fresh air can be energizing, but it can also
activate the parasympathetic nervous system
as you take deep breaths and feel the sun warm
your skin and relax your muscles. Music can also
be either calming or energizing. For instance, I
have a special music playlist that I listen to in the
car that I use on my drive to work in the morning to get my motivation and energy flowing for
the day.
Get present. Caitlin Sykes, Small Business Editor
of the New Zealand Herald, differentiates the
concepts of presenteeism vs. absenteeism in small
businesses. She noted that “... presenteeism is
more hidden than absenteeism,” meaning that
missing work due to illness or life issues isn’t
the only problem workers have when it comes
to productivity: in truth, we are not always very
alert and attentive in our day-to-day work when
we are present at the office. Presenteesim, according to Sykes, is akin to an absence of mindfulness. Presenteeism, in a nutshell, is when a
person is physically present at work, but does
not fully show up. Their attention is elsewhere
or everywhere. The point of being at work is a
bit lost. In private practice, being present in the
28
moment involves alertness and attunement to
self and others. We become perceptive to context and to different points of view. Being present allows psychologists to choose words more
wisely and
to engage
clients with
empathy
and compassion.
Shauna
Shapiro,
Ph.D., of
Santa Clara
University
and her
colleagues
utilized a
Mindfulness-Based
Stress Reduction program to help therapist
trainees become more present, and found that
those who did so reported significantly less
stress, anxiety, and negative emotions, while
also reporting increased positive emotions and
self-compassion (Shapiro, Brown, & Biegel,
2007). By giving as much as we do in our daily
work, it’s important to know what we need to
thrive as professionals. So, while your number of
sick days may not seem to be a problem, it is also
important to take time to check-in about how
much you actually show-up in mind and body.
Use rituals to stay present. During my pre-doctoral internship at UC-Davis, I had a supervisor
who shared a practice of transitioning between
clients. She would hold a stone and imagine
sending any residual emotions and thoughts
from her last client into the stone, freeing herself
to be ready and open for the next person to walk
through the door. I discovered that this particular symbol wasn’t right for me (I was glad to sip
coffee instead), yet I found the idea of transitioning - with intention - appealing. At first, I was
critical of my own coffee ritual, fearing it was
somehow amateur or superficial: what would
my supervisees think of me if that was the best I
could come up with? However, once I was able to
trade in my self-judgment for self-compassion,
my ritual actually facilitated a genuine mindbody transition. I found that I am soothed by the
Winter 2016
ritual of preparing it just the way I like (cream
and sugar, please), smelling the dark roast aroma
(which induces deep breathing), savoring the
bitterness and the sweetness, and feeling the
warmth and heft of the generously-sized mug.
It’s a full sensory experience that carries me out
of the last session and into the present moment,
preparing me for whatever the rest of the day
may bring.
Change it up. Sensory awareness, then, is an
excellent starting point for therapist self-care.
Another tool that is often overlooked, especially
in light of its energizing power, is novelty. The
value of novelty as a self-care strategy may seem
a little unusual at first. Dr. C. Robert Cloninger
and his team of researchers at the Sansone Family Center for Well-Being at Washington University in St. Louis are well known for their exploration of novelty-seeking among drug users,
but recent interviews by Cloninger note that we
all have elements of novelty-seeking behaviors.
When coupled with meaningfulness and persistence, novelty is healthy. According to Cloninger, “Novelty-seeking is one of the traits that
keeps you healthy and happy and fosters personality growth as you age” (Tierney, 2012). As a
neophilic species, humans are drawn to change
things up from time to time. Novelty fuels the
ability to adapt and evolve. This can be seen in
small scale situations (e.g., trying the new cafe
down the street) or larger scale situations (e.g., a
new vacation adventure). Novelty helps to challenge us by engaging feelings of curiosity and
competence, and by filling us with excitement.
Be creative Creativity can also be a valuable
resource in one’s self-care repertoire. Creativity has been an interest of many of psychology’s forefathers, including William James, B.F.
Skinner, Carl Rogers, and Abraham Maslow
(Simonton, 2002). Creativity is by its very definition adaptive; after all, who’s going to bother
to create a worse product or idea. Creativity has
been consistently linked with positive emotion
(Isen, 1999), which has in return been shown to
promote more effective problem-solving (Estrada, Isen, & Young, 1994).
Creative endeavors may include any number of
activities and interests such as cooking, art, journaling, writing, music, and fashion. Too often,
adults abandon creative pursuits to the detriment of their own well-being. Creativity begets
more creativity, and leads to innovation. Psychology is a dynamic profession that relies on
creative thinking, whether it is developing new
insights with clients or developing new ideas for
how to run your practice. Consider what would
help nourish your creative side. For instance,
Katie May, a licensed professional counselor in
Flourtown, PA, specializing in child and adolescent trauma, works with an art therapist outside
of work as a creative outlet that promotes selfcare.
Have fun. Fun is a close cousin of creativity.
Research has accumulated in recent years linking fun and play with increased social, intellectual, and physical resources (Fredrickson, 2002;
Seligman, 2002) and with bringing about a state
of flow (Csikszentmihalyi, 2000). Fun can be an
important personal value, and it doesn’t have
to be excluded from the otherwise serious work
psychologists do. In their book on creatively
approaching private practice, How We Built Our
Dream Practice: Innovative Ideas for Building
Yours, Dave Verhaagen, Ph.D., and Frank Gaskill,
Ph.D. discuss at length the idea of incorporating
fun into their practice. As they point out, fun
serves numerous functions for psychologists.
By being intentional in keeping this value in the
forefront of their mission statement, Verhaagen and Gaskill cultivate creativity, innovation,
enjoyment, and success for the psychologists
in their practice by empowering them to create
their practices on their own terms, and without
taking themselves too seriously. This infusion of
creativity and fun allows the authors to live by
their own rules and make space for what matters to them, while remaining ethical and professional and, in their case, very successful. One of
the ways they cultivate a fun environment is by
posting prank videos on the practice’s Facebook
page; another is to operate a fully functional
coffee shop out of their waiting room. Verhaagen and Gaskill teach that with creativity and
fun, possibilities for a successful practice and for
happy and fulfilled practitioners are limitless.
Their examples illustrate that fun, innovation
and creativity in one’s practice simultaneously
serves the community and supports psychologists’ needs.
Winter 2016
29
Conclusion
As you consider your current self-care strategies, write them down and then reflect on
why you might have gravitated toward those
particular ideas. Convenience? Fun? Escapism?
Comfort? Novelty? Excitement? Relaxation?
The journey of self-care is never-ending, but
as I continue to explore it in both my work life
and my personal life, I recognize that a commitment to self-awareness and self-care significantly informs and elevates my practice and my
life outside of work. Effective self-care informs
which responsibilities I can take on and how
effectively I work with my clients. It feels good
to practice what I preach to clients. Of course
being aware of our needs doesn’t always mean
that we can meet every need we have, but just
developing this awareness is a significant step.
Some of the strategies and ideas in this article
involve trying new self-care strategies and stepping outside the box of our regular day-to-day
lives. At the same time, we may already have
effective tools in our pockets, and we should
not neglect to use them. The ordinary dull moment can still be novel and refreshing when it
is approached with mindfulness, curiosity, and
playfulness.
Further Reading:
Norcross, J. C., & Guy, J. D. (2007). Leaving it at
the office: A guide to psychotherapist selfcare. New York: Guilford Press.
Skovholt, T., & Trotter-Mathison, M. (2011) The
Resilient Practitioner: Burnout prevention &
self-care strategies for counselors, therapists,
teachers, & health care professionals, 2nd Ed.
New York: Routledge.
Weiss, L. (2004). Therapist’s guide to self-care.
New York: Brunner-Routledge
References:
Csikszentmihalyi, M. (2000). Beyond boredom
and anxiety. San Francisco: Jossey-Bass.
Estrada, C. A., Isen, A. M., & Young, M. J. (1994).
Positive affect influences creative problem
solving and reported source of practice
satisfaction in physicians. Motivation and
Emotion, 18, 285-299.
Figley, C. R. (2002). Compassion fatigue: Psy30
chotherapists’ chronic lack of self care.
JCLP/In Session: Psychotherapy is Practice,
58(11), 1433-1441.
Isen, A. M. (1999). On the relationship between
affect and creative problem solving. In S.
Russ (Ed.), Affect, creative experience, and
psychological adjustment. (pp. 3-17). Philadelphia: Taylor and Francis.
Maslach, C., & Goldberg, J. (1998). Prevention
of burnout: New perspectives. Applied &
Preventive Psychology, 7, 63-74.
Seligman, M. E. P. (2002). Authentic Happiness.
New York: Free Press.
Shapiro, S. L., Brown, K. W., & Biegel, G. M.
(2007). Teaching self-care to caregivers:
Effects of mindfulness-based stress reduction on the mental health of therapists in
training. Training and Education in Professional Psychology, 1(2), 105-115.
Simonton, D. K. (2002). Creativity. In C. R. Snyder & S. J. Lopez (Eds.), Handbook of Positive
Psychology (pp. 189-201). New York: Oxford University Press.
Sykes, C. (2015). Small Business: Absenteeism
and presenteeism. New Zealand Herald. Retrieved from http://www.nzherald.co.nz/
business/news/article.cfm?c_id=3&objectid=11525312
Skovholt, T. M., & Ronnestad, M. H. (2003).
Struggles of the novice counselor and therapist. Journal of Career Development, 30,
45–58.
Tierney, J. (2012, February 13). What’s New?
Exuberance for novelty has benefits. New
York Times. Retrieved from http://www.
nytimes.com.
Vredenburgh, L. D., Carlozzi, A. F., & Stein, L. B.
(1999). Burnout in counseling psychologists: Type of practice setting and pertinent demographics. Counseling Psychology
Quarterly, 12, 293–302.
Verhaagen, D., & Gaskill, F. (2014). How We Built
Our Dream Practice: Innovative Ideas for
Building Yours. Camp Hill, PA: TPI Press.
Weiss, L. (2004). Therapist’s guide to self-care.
New York: Brunner-Routledge.
Karin Lawson, PsyD is a clinical psychologist licensed in Florida and California. She is a Certified
Eating Disorder Specialist (CEDS) as recognized by
Winter 2016
the International Association for Eating Disorder
Professionals (IAEDP). Her practice focuses on eating disorders, with a special passion for binge eating disorder. She has a background in health psychology and works to support those clients whose
mental health intersect with their medical diagnoses. Previously, she worked for The Renfrew Center
and was a clinical director at Oliver-Pyatt Centers
for 5 years, opening their Embrace programming
for binge eating disorder. She is a member of the
Binge Eating Disorder Association (BEDA), International Association for Eating Disorder Professionals,
American Psychological Association, and Florida
Psychological Association. She enjoys speaking at
regional and national conferences on the topics
of self-compassion, body image, and use of self in
therapy. In addition to her clinical work, Karin is a
registered yoga teacher with a certification in Curvy
Yoga, making yoga accessible to all body sizes and
abilities.
Multicultural and Diversity
Building Self-awareness and Enhancing
Multicultural Competencies in Practice
Aaron A. Gubi, Joel O. Bocanegra and Adrienne Garro
D
iversity is no longer just a buzz word in
society. It is a real construct that has
become embedded in our everyday lives and
psychological practice. Diversity presents itself
in a variety of forms that can impact the therapeutic relationship. As psychologists we often
think of how racial, cultural, or gender differences can contribute to diversity. It is also important to acknowledge how diversity in areas
such as physical or developmental disability,
language, sexuality, or socioeconomic and class
differences can also strongly influence self-development and, thus, shape subsequent understanding, immersion and well-being within
clients’ worlds. This article will examine growing diversity within our society and present a
model for developing effective diversity skills
in clinical practice. Next, we will explore how
self-awareness of one’s own background can
enhance our therapeutic competency. Lastly,
this paper will present two simple exercises
the reader can complete to enhance their own
diversity self-awareness.
Need for Cultural Competency
The United States continues to diversify at an
increasing rate. Currently, more than one-third
of all Americans are from non-White racial or
ethnic backgrounds, with census data suggesting that the percentage of individuals from minority backgrounds stands at 36.3% as of 2010.
Trends suggest the United States will continue
to diversify in the coming decades, and will
become a majority-minority nation, in which
there is no clear ethno-cultural majority group,
within the next two to three decades (Lichter,
2013). In addition to growing racial and ethnic
diversity, perspectives on physical, cognitive,
and acquired disability; sexual/gender orientation, and socioeconomic/class differences are
rapidly changing, challenging perceived expectations many hold (Duan & Brown, 2016). The
increasingly diverse composition of our society
makes it imperative that psychologists uphold the ethical principles of our profession in
providing beneficence and nonmaleficent care
with fidelity, justice and respect for the rights
and dignity of all clients (American Psychological Association, 2010).
Cultural Competency
The changing demographics of American
society necessitate that psychologists possess
clinical and interpersonal skills necessary to
effectively provide clinical services with a diverse array of clients. To address diversity most
succinctly for psychologists, Sue and colleagues
proposed a tri-partite model of cultural com-
Winter 2016
31
petence in psychological practice, one that has
become accepted within large segments of the
profession and seeks to promote care to individuals from diverse backgrounds (Arrendondo &
Tovar, 2014; Sue & Sue, 2013). In this model,
they call for greater knowledge and awareness
of: a) one’s own personal beliefs, values, biases,
and attitudes, (2) the worldview of culturally
diverse individuals and groups, and (3) increased
understanding and utilization of culturally appropriate intervention skills and strategies.
Many have argued that critical self-reflection is
a vital starting point for the self-examination
and interpersonal growth that is necessary to
provide culturally competent care to diverse clients (Roysircar, 2004). Specifically, both practitioners and scholars have argued that engagement in self-awareness building exercises is
one way to promote self-reflection and improve
capacities to critically examine self and others.
This, in turn, leads to strengthening of abilities
to engage in culturally competent practices
with diverse clientele (Weigl, 2009).
Self-awareness Exercises and Cultural Competency
Exercise I – Examining our Privilege
In 1988 Peggy McIntosh wrote a now classic
article on White Privilege (McIntosh, 1988),
which can be found in the public domain of the
internet (http://www.cirtl.net/files/PartI_CreatingAwareness_WhitePrivilegeUnpackingtheInvisibleKnapsack.pdf). McIntosh describes
white privilege as a constellation of seemingly
invisible, unacknowledged, and unearned array
of benefits. In her analysis, White individuals,
and males in particular, are examined as accruing these unearned privileges. While this
article was and remains controversial to some
(Lensmire et al., 2013), one of its major points
is that individuals gain advantages and disadvantages at birth due to their racial and ethnic
backgrounds and gender, which can impact life
trajectories and outcomes in a myriad of ways.
McIntosh challenges her readers to examine
their own privileged background in her initial
and subsequent works within both academic
32
and applied settings.
To examine self-perceptions of your own
privilege, complete
the following exercise adapted from
McIntosh: http://www.
whatsrace.org/images/
inventory.pdf Higher
scores are related to
higher privilege and
lower scores to less
privilege. However,
in completing this
activity, do not just
consider your score.
Ask yourself how you
feel while you are
completing it. Do you
feel anger, ambivalence, or annoyance
while you are completing this exercise?
To further enhance
awareness building,
have colleague(s),
friend(s) or partner(s)
complete the same
questionnaire and
discuss your outcomes together.
Aaron A. Gubi
Joel O. Bocanegra
Exercise II – Intersectionality and the
ADDRESSING Model
The idea of white
privilege has been ex- Adrienne Garro
amined more recently through the lens of intersectionality. Intersectionality recognizes that individuals can be
privileged in some manners and not privileged
in others. For example, President Obama was
privileged to be born into a family that promoted learning and intellectual curiosity, and had
the socioeconomic opportunity to allow him
to develop within a variety of diverse cultures,
countries, and institutions while he was growing up. However, President Obama was not
privileged in terms of his racial or ethnic background. Intersectionality recognizes that priv-
Winter 2016
ilege can accrue in certain domains and not in
others, making this perspective a suitable one
with which to examine individual differences.
The ADDRESSING model, proposed by psychologist Pamela Hays, is a framework to examine
individual differences and privilege through an
intersectionality lens (Hays, 2013). Our ability
Domain
are important for each domain. Then complete
the right column by reflecting on your responses
within the middle column and recording Yes or
No into each section on the right hand side. If
responses from the column can be classified as a
YES response in the right column, you might be
dominant/privileged in that area. As described
by Hays (2008), the ADDRESSING framework
Complete this section for
yourself and/or consider a
client when completing it
Examine your responses in the middle column. In each
space below, record a Yes if your response fits within
the purview below or a No if not.
Age and Generational Influences
Are between the ages of 18-64
Disability status
Do not have a physical or developmental disability
Disability acquired in life
Have not acquired a disability in life (e.g., TBI, MS)
Religion and spirituality
Are Christian or from a family that relates with
Christian spiritual, cultural and religious values
Ethnic/racial identity
Are from a Caucasian/White background
Socioeconomic status
Are from the middle class or higher
Sexual orientation
Identify as heterosexual
Indigenous/native heritage (e.g.,
Native American, Alaskan Native)
Do not identify as being from an Indigenous heritage/
background
National origin
Your national origin is American or European
Gender
You are male
to more broadly identify privileges can be critical in the development of diversity since many
of these privileges are often imperceptible to
their holders. These unacknowledged, unsolicited benefits can potentially blind psychologists
to the significance of the culturally mediated
experiences of their clients, and, thus, engagement with this model might help psychologists
be better equipped to examine diversity factors within themselves and their clients. This
model is broken down into specific areas that
include Age, Developmental disability, Disability acquired in life; Religion and spirituality;
Ethnic/racial identity; Socioeconomic status;
Sexual orientation; Indigenous heritage; National origin, and Gender (Hays, 2008; 2013).
This activity is modified from the work of Hays.
To complete this activity, complete the middle
column the best you can. On a separate sheet of
paper, reflect upon each domain of the addressing model and record a brief description of the
personal influences/experiences that you believe
can also be applied with clients and used as a
tool to enhance their own self-awareness and
socio-emotional functioning.
After completing these exercises, reflect upon
your responses and consider them from an
integrated perspective. Has your perspective of
self as an individual and practitioner changed?
If so, how? Think of a client from a background
different from your own. How might your responses converge or diverge from those of your
client? How might your client(s) complete each
exercise? Some additional questions to consider:
•
How have the experiences recorded within
the Privilege and ADDRESSING framework
benefited me?
•
What have I done to deserve these benefits?
•
How have these experiences hurt or otherwise negatively influenced me?
•
What would my life be like if I had not benefited from such experiences or advantages?
Winter 2016
33
•
How will I use this new knowledge in order
to benefit my clients?
There was a time when psychologists could expect that their clients who entered their office
would be White /Caucasian, heterosexual, from
middle to upper-middle class socioeconomic backgrounds. Those days are gone. Today,
psychologists, regardless of their work setting,
will encounter clients from varied backgrounds
and life experiences, Different facets of one’s
background and life experiences, including the
areas of race, gender, sexual orientation, disability and socioeconomic status – interact with
one another and generate a series of complex
reciprocal worldviews that we must confront in
order to gain awareness and, ultimately, acceptance of our life experiences. As practitioners,
we know such individual differences can impact the therapeutic relationship in a multitude
of ways. We hope these self-awareness building
exercises have helped our colleagues enhance
the life-long process of developing multicultural and other competencies related to diversity.
Works Cited
American Psychological Association (2010).
2010 Amendments to the 2002 ‘Ethical
principles of psychologists and code of
conduct’. American Psychologist, 65(5), 493493. doi: 10.1037/a0020168
Arrendondo, P., & Tovar-Blank, Z. G. (2014).
Multicultural competencies: A dynamic paradigm for the 21st century. In F. T. L. Leong,
L. Comas-Díaz, G. C. Nagayama Hall, V. C.
McLoyd & J. E. Trimble (Eds.), APA handbook
of multicultural psychology, Vol. 2: Applications and training. (pp. 19-34). Washington,
DC: American Psychological Association.
Duan, C., & Brown, C. (2016). Becoming a multiculturally competent counselor. New York: Sage.
Hays, P. A. (2008). Addressing cultural complexities in practice: Assessment, diagnosis, and
therapy (2 ed.). Washington, DC, US: American Psychological Association.
Hays, P. A. (2013). Connecting Across Cultures.
New York: Sage.
Lensmire, T. J., McManimon, S. K., Tierney, J. D.,
Lee-Nichols, M. E., Casey, Z. A., Lensmire,
34
A., et al. (2013). McIntosh as synecdoche:
How teacher education’s focus on White
privilege undermines antiracism. Harvard
Educational Review, 83(3), 410-431.
Lichter, D. (2013). Integration or fragmentation? Racial diversity and the American
future. Demography, 50(2), 359-391. doi:
10.1007/s13524-013-0197-1
McIntosh, P. (1988). White privilege and male
privilege: A personal account of coming to see
correspondences through work in women’s
studies. Working Paper No. 189. Wellesley,
MA: Wellesley Centers for Women.
Roysircar, G. (2004). Cultural Self-Awareness
Assessment: Practice Examples From Psychology Training. Professional Psychology:
Research and Practice, 35(6), 658-666.
Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and practice (6th ed.).
Hoboken, N.J.: John Wiley & Sons.
Weigl, R. C. (2009). Intercultural competence
through cultural self-study: A strategy
for adult learners. International Journal of
Intercultural Relations, 33(4), 346-360. doi:
http://dx.doi.org/10.1016/j.ijintrel.2009.04.004
Aaron A. Gubi, Ph.D., is an Assistant Professor
in the combined School and Clinical Psychology
program at Kean University. A licensed psychologist
and nationally certified school psychologist, he has
clinical and research interests in the areas of child
maltreatment/trauma, multicultural competency
practices and autism spectrum disorders.
Joel O. Bocanegra, Ph.D., is an Assistant Professor
at Idaho State University who specializes in multicultural competency, diversity recruitment, and system-wide interventions. He received his PhD from
the University of Wisconsin-Milwaukee. Adrienne Garro, Ph.D. is an Associate Professor in
the Department of Advanced Studies in Psychology
at Kean University and program coordinator for
Kean’s School Psychology Professional Diploma Program. She is a licensed psychologist and certified
school psychologist with clinical and research interests in the areas of emotional regulation interventions for children and early childhood assessment.
Correspondence concerning this article should be
addressed to Aaron A. Gubi, Department of Advanced
Studies in Psychology, Kean University, 1000 Morris
Avenue, Union, NJ 07083. EMAIL: [email protected]
Winter 2016
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